Short-term echocardiographic follow-up after hospitalization for COVID-19: a focus on early post-acute changes

Abstract

BackgroundImpaired physical functional status is one of the typical long-term sequelae of COVID-19 infection that significantly affects the quality of life and work capacity. Minor changes in cardiac structure and function that are unable to cause the manifestation of overt heart failure may remain undetected in COVID-19 convalescents, at the same time potentially contributing to the persistence of symptoms and development of long COVID syndrome.PurposeTo study the typical features and short-term dynamics of cardiac remodeling and possible signs of cardiac dysfunction following hospitalization for COVID-19.MethodsThis is a combined cross-sectional and longitudinal cohort study in which 176 hospitalized patients (93 female and 83 male, mean age 53.4 ± 13.6 years) with COVID-19 infection underwent comprehensive transthoracic echocardiography pre-discharge (22.6 ± 7.1 days from the onset of symptoms) with repeated evaluation after 1 month. The control group included 88 age-, sex-, height- and weight-matched healthy individuals, with a subset of those (n = 53) matched to the subset of non-hypertensive study participants (n = 106).ResultsConcentric left ventricular geometry was revealed in 59% of participants, including 43% of non-hypertensive subjects; predominantly Grade I diastolic dysfunction was found in 35 and 25% of patients, respectively. Other findings were naturally following from described phenotype of the left venticle and included a mild increase in the absolute and relative wall thickness (0.45 ± 0.07 vs. 0.39 ± 0.04, p < 0.001), worsening of diastolic indices (e’ velocity 9.2 ± 2.2 vs. 11.3 ± 2.6 cm/s, p < 0.001, E/e’ ratio 7.5 ± 1.8 vs. 6.8 ± 1.7, p = 0.002) and global longitudinal strain (17.5 ± 2.4 vs. 18.6 ± 2.2, p < 0.001). No significant improvement was found on re-evaluation at 1 month.ConclusionsHospitalized patients recovering from COVID-19 were characterized by a high prevalence of left ventricular concentric remodeling, predominantly Grade I diastolic dysfunction, and a mild decrease in the longitudinal systolic function. These changes were less frequent but still prevalent in the non-hypertensive subgroup and largely persisted throughout the 1-month follow-up.

Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome—insights from mid-term follow-up by cardiovascular magnetic resonance

“…Similar findings with a shorter FU were published recently based on CMR data ( 47 ). The authors reported lower strain rates at baseline; this finding is backed-up by recent evidence from echocardiography, suggesting that these changes already take place in patients shortly after an acute COVID-19 infection ( 48 ). Overall and in accordance with our findings, strain indexes seem to improve on FU ( 49 ).…”

A prognostic model and pre-discharge predictors of post-COVID-19 syndrome after hospitalization for SARS-CoV-2 infection

“…Retrospective assessment of echocardiographic features of observed patients has only revealed minor differences between PCS and non-PCS study participants (see Table 3 ). Both groups were showing a strong trend to concentric LV remodeling [refer to ( 27 ) for the detailed comparison to matched control], and patients who were subsequently reporting long-lasting symptoms had somewhat smaller ventricular cavities. Despite this fact, systolic atrioventricular annuli excursion was comparable to PCS-free patients, translating into somewhat higher longitudinal strain values (reaching statistical significance in case of RV).…”

A Significance of Endothelial Dysfunction in Long COVID-19 for The Possible Future Pandemic of Chronic Kidney Disease and Cardiovascular Disease

“…Hospitalized patients recovering from COVID-19 were characterized by a high prevalence of left ventricular concentric remodeling, predominantly Grade I diastolic dysfunction, and a mild decrease in the longitudinal systolic function. These changes were largely persisted throughout the 1-month follow-up [87]. The Hong Kong Hospital Authority and the UK Biobank databases showed that patients with COVID-19 incurred greater risk of HF (HR 1.82; 95% CI 1.65, 2.01) during their post-acute phase of infection [85].…”